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Saving babies is saving money
86
TUESDAY,
progressively lower for twin-2 compared to all tgwins p value ranging from 0.05 to 0.01 Apgar scores a 5 minutes were better for twins _ 1 compare to twin-2, only after tdi 60 minutes ( p.c. 0.05). no significant difference occurred ( = 0.05) in pm between tgwin-2, compared to twin-l , for different modes of delivery, for different tdi. Conclusion: The best outcome for second twin occurs if its delivery takes place withinn 10 minutes of delivery of the first. No significant difference occurs in pm between the second and the first twin with increasing twin- delivery interval.
FC2.35
OBSTETRICS DELIVERY
AND GYNECOLOGY
HEALTH
FC2.35.01 SAVING BABIES IS SAVING MONEY S. Semchvshvn, Chuckey, TN, USA Introduction: Modern medical technology has enabled us to diagnose and treat various conditions in pregnancy, yet we are still losing a staggering number of babies to miscarriage and prematurity. Discussion: We have increased our knowledge and capabilities in perinatal medicine, yet preamturity rate is higher today than it was 50 years ago. By making every pregnancy count I have been winning small battles and found ways of improving the outcome of pregnancy. By allowing and encouraging patients to become partners in their pregnancy we have been able to achieve unparalleled outcomes, term pregnancy in over 97% of high-risk pregnancies. Partnership in Pregnancy and Pregnancy Literacy helped dreams come true for those who were told to abandon their dream of having a baby of their own. By enabling the patients themselves to monitor their pregnancies and take active steps of avoiding aggravating circumstances and, when needed, take active steps to minimize these risks, we have been able to optimally conclude pregnancies even under the most adverse circumstances. Not only have we been able to save the lives of babies, but much grief and pain was also avoided, and scarce health care dollars spared from being wasted. Conclusions: Attention to detail, coupled with an aggressive approach to making every pregnancy count can significantly reduce miscarriage and preterm birth rates and save our babies from needless loss. By doing so, we do indeed save money in the long run.
FC2.35.02 CHANGES IN THE DELIVERY ROOM: AN ALTERNATIVE WAY TO REDUCE THE C-SECTION RATE AND EPISIOTOMY RATE IN A BRAZILIAN HOSPITAL M. M.Ymayo, Hospital Santa Marcelina Itaim Paul&a, Sfo Paula, Brazil. Objectives: In Brazil, the C-section rate is 75% in Private Sector and 35% in Public Hospitals. The episiotomy rate is 90% to 100% for both Hospitals System. This study compares the results for c-section, episiotomies rates and economics savings obtained with a humanized administration in a traditional Health Care Delivery System in a developing country. Study Methods: We evaluated the monthly rates for c-section and episiotomies from May to December 1999, in a total of 4000 deliveries at Saint Marceline Hospital - Itaim Paul&a, Sfo Paula, SP. We abandoned the traditional Obstetric Center and all the births occurred in Individual Deliveries Rooms with family involvement. We implemented seminaries and workshops monthly to all doctors and nurses, individual statistics analyzes for all professionals, a program of quality and continuous education, training in emergency situations, costumers courses and involved the local community in the program. Results: Our episiotomy rate is 18% to 22% (a reduction of 80% in the national rate) and the c-section rate was 11% to 20% monthly (42% of reduction from the national rate), 60% of the deliveries were assisted by obstetrics nurses, routines like pubic shave and fleet enema was abandoned. The cost of a birth is 30% cheaper than the traditional. Conclusions: In a development country like Brazil, we concluded that is possible to implement policies to reduce the episiotomy rate and csection rate. In the same time, it is possible to save money and improve the Quality of the Obstetric Care System in Brazil.
SEPTEMBER
5
FC2.35.03 PARTICIPATORY NEEDS ASSESSMENTS : RESPONDING TO SUBNATIONAL VARIATIONS H. Ashwood-Smith, M. Bokosi, P. Matinga, H. Simpson, .I. Hussein, Safe Motherhood Project, Blantyre, Malawi. Objectives: This study was conducted in southern Malawi to explore issues pertaining to quality of obstetric care and to determine sub-national variations for refinement of the Safe Motherhood Project’s implementation strategy. Study Methods: An integrated approach was employed combining quantitative and qualitative methodologies. A Knowledge, Attitude and Practice survey (targeting men, and women of childbearing age) used a multi-stage stratified sampling technique (n = 3400). Convenience sampling was employed with health personnel (n = 402) and a census was performed with the Traditional Birth Attendants (TBAs)(n = 327). Participatory Learning for Action (PLA) techniques were conducted with all respondent groups, triangulating results. Five districts were surveyed. Results: Comparisons between lowest, and highest scoring districs yielded significant differences. Women’s awareness of danger signs varied froom 15% to 43% (p=O.O02). Satisfaction levels differed markedly by 22% (p
FC2.35.04 ARE BICYCLE AMBULANCES AND COMMUNITY TRANSPORT PLANS EFFECTIVE IN STRENGTHENING OBSTETRIC REFERRAL SYSTEMS IN SOUTHERN MALAWI? K.Luneu, V. Kamfose, B.Chilwa, J.Hussein, Safe Motherhood Project, Blantyre, Southern Region, Malawi. Objectives: One critical component of the Safe Motherhood Project is to strengthen obstetric referral systems. A community-based case control study was conducted in Southern Malawi to determine the timeeffectiveness, cost-effectiveness and cultural acceptability of bicycle ambulances (BAs) and established community transport plans (CTPs). Another aim was to determine whether the presence of CTPs influence home delivery rates. The study was conducted from July 19th 1999 to January 18th, 2000. Study methods: The study employed qualitative and quantitative methodologies to collect data from 10 villages located within a five kilometer radius to three Basic Essential Obstetric Care(BEOCs) facilities. Distance, socio-economic status, topography, culture and ethnicity were considered when controlling for sites. Of the four case villages, two were provided with BAs and two developed transport plans; the six control villages lacked established plans. 30 homogeneous focus group discussions (FGDs) explored perceptions of modes of transport with elders, chiefs, women of child-bearing age, and their partners. Retrospective interviews with women delivering six months prior to the study (n=92) obtained baseline data, whilst prospectively 157 deliveries were registered. Results: Home delivery rates in case villages decreased from 37% to 18% (P
TUESDAY,
progressively lower for twin-2 compared to all tgwins p value ranging from 0.05 to 0.01 Apgar scores a 5 minutes were better for twins _ 1 compare to twin-2, only after tdi 60 minutes ( p.c. 0.05). no significant difference occurred ( = 0.05) in pm between tgwin-2, compared to twin-l , for different modes of delivery, for different tdi. Conclusion: The best outcome for second twin occurs if its delivery takes place withinn 10 minutes of delivery of the first. No significant difference occurs in pm between the second and the first twin with increasing twin- delivery interval.
FC2.35
OBSTETRICS DELIVERY
AND GYNECOLOGY
HEALTH
FC2.35.01 SAVING BABIES IS SAVING MONEY S. Semchvshvn, Chuckey, TN, USA Introduction: Modern medical technology has enabled us to diagnose and treat various conditions in pregnancy, yet we are still losing a staggering number of babies to miscarriage and prematurity. Discussion: We have increased our knowledge and capabilities in perinatal medicine, yet preamturity rate is higher today than it was 50 years ago. By making every pregnancy count I have been winning small battles and found ways of improving the outcome of pregnancy. By allowing and encouraging patients to become partners in their pregnancy we have been able to achieve unparalleled outcomes, term pregnancy in over 97% of high-risk pregnancies. Partnership in Pregnancy and Pregnancy Literacy helped dreams come true for those who were told to abandon their dream of having a baby of their own. By enabling the patients themselves to monitor their pregnancies and take active steps of avoiding aggravating circumstances and, when needed, take active steps to minimize these risks, we have been able to optimally conclude pregnancies even under the most adverse circumstances. Not only have we been able to save the lives of babies, but much grief and pain was also avoided, and scarce health care dollars spared from being wasted. Conclusions: Attention to detail, coupled with an aggressive approach to making every pregnancy count can significantly reduce miscarriage and preterm birth rates and save our babies from needless loss. By doing so, we do indeed save money in the long run.
FC2.35.02 CHANGES IN THE DELIVERY ROOM: AN ALTERNATIVE WAY TO REDUCE THE C-SECTION RATE AND EPISIOTOMY RATE IN A BRAZILIAN HOSPITAL M. M.Ymayo, Hospital Santa Marcelina Itaim Paul&a, Sfo Paula, Brazil. Objectives: In Brazil, the C-section rate is 75% in Private Sector and 35% in Public Hospitals. The episiotomy rate is 90% to 100% for both Hospitals System. This study compares the results for c-section, episiotomies rates and economics savings obtained with a humanized administration in a traditional Health Care Delivery System in a developing country. Study Methods: We evaluated the monthly rates for c-section and episiotomies from May to December 1999, in a total of 4000 deliveries at Saint Marceline Hospital - Itaim Paul&a, Sfo Paula, SP. We abandoned the traditional Obstetric Center and all the births occurred in Individual Deliveries Rooms with family involvement. We implemented seminaries and workshops monthly to all doctors and nurses, individual statistics analyzes for all professionals, a program of quality and continuous education, training in emergency situations, costumers courses and involved the local community in the program. Results: Our episiotomy rate is 18% to 22% (a reduction of 80% in the national rate) and the c-section rate was 11% to 20% monthly (42% of reduction from the national rate), 60% of the deliveries were assisted by obstetrics nurses, routines like pubic shave and fleet enema was abandoned. The cost of a birth is 30% cheaper than the traditional. Conclusions: In a development country like Brazil, we concluded that is possible to implement policies to reduce the episiotomy rate and csection rate. In the same time, it is possible to save money and improve the Quality of the Obstetric Care System in Brazil.
SEPTEMBER
5
FC2.35.03 PARTICIPATORY NEEDS ASSESSMENTS : RESPONDING TO SUBNATIONAL VARIATIONS H. Ashwood-Smith, M. Bokosi, P. Matinga, H. Simpson, .I. Hussein, Safe Motherhood Project, Blantyre, Malawi. Objectives: This study was conducted in southern Malawi to explore issues pertaining to quality of obstetric care and to determine sub-national variations for refinement of the Safe Motherhood Project’s implementation strategy. Study Methods: An integrated approach was employed combining quantitative and qualitative methodologies. A Knowledge, Attitude and Practice survey (targeting men, and women of childbearing age) used a multi-stage stratified sampling technique (n = 3400). Convenience sampling was employed with health personnel (n = 402) and a census was performed with the Traditional Birth Attendants (TBAs)(n = 327). Participatory Learning for Action (PLA) techniques were conducted with all respondent groups, triangulating results. Five districts were surveyed. Results: Comparisons between lowest, and highest scoring districs yielded significant differences. Women’s awareness of danger signs varied froom 15% to 43% (p=O.O02). Satisfaction levels differed markedly by 22% (p
FC2.35.04 ARE BICYCLE AMBULANCES AND COMMUNITY TRANSPORT PLANS EFFECTIVE IN STRENGTHENING OBSTETRIC REFERRAL SYSTEMS IN SOUTHERN MALAWI? K.Luneu, V. Kamfose, B.Chilwa, J.Hussein, Safe Motherhood Project, Blantyre, Southern Region, Malawi. Objectives: One critical component of the Safe Motherhood Project is to strengthen obstetric referral systems. A community-based case control study was conducted in Southern Malawi to determine the timeeffectiveness, cost-effectiveness and cultural acceptability of bicycle ambulances (BAs) and established community transport plans (CTPs). Another aim was to determine whether the presence of CTPs influence home delivery rates. The study was conducted from July 19th 1999 to January 18th, 2000. Study methods: The study employed qualitative and quantitative methodologies to collect data from 10 villages located within a five kilometer radius to three Basic Essential Obstetric Care(BEOCs) facilities. Distance, socio-economic status, topography, culture and ethnicity were considered when controlling for sites. Of the four case villages, two were provided with BAs and two developed transport plans; the six control villages lacked established plans. 30 homogeneous focus group discussions (FGDs) explored perceptions of modes of transport with elders, chiefs, women of child-bearing age, and their partners. Retrospective interviews with women delivering six months prior to the study (n=92) obtained baseline data, whilst prospectively 157 deliveries were registered. Results: Home delivery rates in case villages decreased from 37% to 18% (P